Comparison of functional outcomes after retropubic, laparoscopic and robot-assisted radical prostatectomy: A meta-analysis

doi:10.13105/wjma.v2.i3.107

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Meta-Analysis

World J Meta-Anal. Aug 26, 2014; 2(3): 107-126
Published online Aug 26, 2014. doi: 10.13105/wjma.v2.i3.107

Table 1 Comparative studies evaluating urinary continence recovery after retropubic radical prostatectomy or laparoscopic radical prostatectomy

Quality	Case, n	Ref.	Country	Age (yr)	BMI (kg/m²)	Prostate vol-ume (mL, g)	Gleason sc-ore (biopsy)	PSA (ng/mL)	Study design	Continence definition	Data collection	Loss of follow-up (N/Y, %)	Urinary continence recovery, %(n)
Quality	Case, n	Ref.	Country	Age (yr)	BMI (kg/m²)	Prostate vol-ume (mL, g)	Gleason sc-ore (biopsy)	PSA (ng/mL)	Study design	Continence definition	Data collection	Loss of follow-up (N/Y, %)	6 mo	12 mo
3/2/2(H)	RRP, 70	Anastasiadis et al[20], 2003	France	64.8 ± 6.4	-	-	6.1 ± 1.1	11.2 ± 9.7	Prospective	0 pad	Nonvalidated	Y, > 20%	43.3 (16/37)	77.7 (26/33)
	LRP, 230	Anastasiadis et al[20], 2003		64.1 ± 6.4			5.8 ± 1.2	10.7 ± 8.8			questionnaire		59.2^a (67/113)	89.0 (94/106)
2/2/3(H)	RRP, 77	Roumeguere et al[21], 2003	Belgium	63.9 ± 5.5	-	42.0 ± 20.4	5.4 ± 1.5	10.5 ± 11.5	Prospective	0 pad	Interview	Y, > 20%	62.5 (40/64)	83.9 (47/56)
	LRP, 85	Roumeguere et al[21], 2003		62.5 ± 6.0		37.3 ± 15.6	5.4 ± 1.5	8.6 ± 5.2					50.6 (37/73)	80.7 (42/52)
3/1/3(H)	RRP, 41	Remzi et al[22], 2005	Austria	60 ± 14	-	44 ± 18	4.7 ± 1.5	6.9 ± 4.4	Prospective	0 pad	Physician	N	-	80.3 (33/41)
	(a)tLRP, 39			61 ± 11		37 ± 16	5.1 ± 1.2	5.5 ± 3.7						84.6 (33/39)
	(b)eLRP, 41			59 ± 12		32 ± 14	5.5 ± 1.3	8.1 ± 6.1						87.8 (36/41)
3/2/3(H)	RRP, 75	Wagner et al[23], 2007	United States	59 ± 6.9	29 ± 4.5	-	-	8.1 ± 6.27	Prospective	0 pad	EPIC	Y, < 20%	-	47.0 (31/66)
	LRP, 75	Wagner et al[23], 2007		58 ± 6.9	27 ± 3.0			6.2 ± 4.22						64.0^a (43/67)
3/2/2(H)	RRP, 222	Touijer et al[24], 2008	United States	59 (54, 64)	-	-	-	5.3 (4.1, 7.3)	Prospective	0-1 safety	Institutional	N	-	75.0^a (167/222)
	LRP, 193	Touijer et al[24], 2008		60 (55, 65)				5.3 (4.0, 7.5)		pad	questionnaire			48.0 (93/193)
3/2/3(H)	RRP, 150	Greco et al[25], 2009	Italy	61.5 (49-74)	29 (25-33)	-	5 (3-7)	6.95 (3.4-10)	Prospective	0 pad	Validated	N	76.0 (114/150)	91.0 (137/150)
	LRP, 150	Greco et al[25], 2009		60.5 (45-76)	32 (26-38)		5 (3-7)	6.3 (2.4-10)			questionnaire		89.3 (134/150)	97.0 (146/150)
3/2/2(H)	RRP, 102	Dahl et al[26], 2009	United States	59.9	-	-	-	-	Prospective	0 pad	Validated	Y, > 20%	49.0 (38/78)	49.0 (35/72)
	LRP, 104	Dahl et al[26], 2009		59.5							questionnaire		42.0 (31/74)	53.0 (41/78)
2/2/2(M)	RRP, 49	Egawa et al[27], 2003	Japan	67.0 ± 0.7	-	-	6.0 ± 0.2	8.3 ± 1.4	Retrospective	0 pad	Interview	Y, > 20%	84.1^a (37/44)	92.9^a (39/42)
	LRP, 34	Egawa et al[27], 2003		68.0 ± 0.9			5.0 ± 0.2	6.6 ± 0.6					46.9 (15/32)	60.0 (12/20)
3/1/2(M)	RRP, 50	Artibani et al[28], 2003	Italy	64.28 ± 6.6	-	-	5.7 ± 1.2	11 ± 9	Retrospective	0 pad	Nonvalidated	Y, > 20%	-	64.0 (9/14)
	LRP, 71	Artibani et al[28], 2003		63.14 ± 5.8			5.8 ± 1.3	15.7 ± 17			questionnaire			40.0 (8/20)
4/2/2(H)	RRP, 70	Ghavamian et al[29], 2006	United States	57.8 ± 7.3	28.1	53.2 (19-135)	6.7 ± 1.3	9.9 ± 7.1	Retrospective	0 pad	Physician	Y, < 20%	71.4 (50/70)	87.6 (57/65)
	LRP, 70	Ghavamian et al[29], 2006		60.8 ± 6.1	27.5	40.8 (20-114)	6.4 ± 0.8	7.6 ± 8.0					70.0 (49/70)	90.0 (63/70)
4/2/2(H)	RRP, 37	Takenaka et al[30], 2008	Japan	67.1 ± 6.0	23.5 ± 3.0	30.1 ± 26.9	6.9 ± 1.0	14.7 ± 11.9	Retrospective	0 pad	Nonvalidated	N	77.0 (28/37)	91.0 (34/37)
	LRP, 109	Takenaka et al[30], 2008		66.1 ± 6.3	23.8 ± 2.5	32.2 ± 16.5	6.6 ± 0.7	11.0 ± 8.4			questionnaire		65.0 (71/109)	77.0 (84/109)
2/2/3(H)	RRP, 188	Simforoosh et al[31], 2009	Iran	62.1 (45-74)	-	-	-	13.6	Retrospective	0 pad	Physician	N	91.5 (172/188)	95.2 (179/188)
	LRP, 136	Simforoosh et al[31], 2009		62.5 (45-76)				12.7					89.0 (121/136)	96.3 (131/136)
2/1/1(M)	RRP, 128	Springer et al[32], 2013	Germany	57.2 ± 7.4	28.3 ± 2.6	-	-	3.1 ± 1.7	Retrospective	0 pad	Validated	N	73.4 (94/128)	86.4 (111/128)
	LRP, 125	Springer et al[32], 2013		56.8 ± 6.7	27.7 ± 3.8			3.2 ± 1.4			questionnaire		86.4 (108/125)^a	96.8^a (121/125)
3/2/2(H)	RRP, 168	Magheli et al[33], 2014	Germany	62.6 ± 5.4	-	58 ± 22	-	10.1 ± 11.9	Retrospective	0-1 safety	Validated	Y, > 20%	-	83.2 (99/119)
	LRP, 171	Magheli et al[33], 2014		62.3 ± 5.7		53 ± 20		9.2 ± 6.9		pad	questionnaire			82.8 (96/116)

^aP < 0.05. RRP: Retropubic radical prostatectomy; LRP: Laparoscopic radical prostatectomy; (a)tLRP: Transperitoneal laparoscopic radical; EPIC: Expanded prostate cancer index composite.

Table 2 Comparative studies evaluating urinary continence recovery after retropubic radical prostatectomy or robot-assisted radical prostatectomy

Quality	Case, n	Ref.	Country	Age (yr)	BMI (kg/m²)	Prostate volume (mL, g)	Gleason score (biopsy)	PSA (ng/mL)	Study design	Continence definition	Data collection	Loss of follow-up (N/Y,%)	Urinary continence recovery, %(n)
Quality	Case, n	Ref.	Country	Age (yr)	BMI (kg/m²)	Prostate volume (mL, g)	Gleason score (biopsy)	PSA (ng/mL)	Study design	Continence definition	Data collection	Loss of follow-up (N/Y,%)	6 mo	12 mo
3/2/3(H)	RRP, 100	Tewari et al[34], 2003	United States	63.1 (42.8-72)	27.6 (17-41)	48.4 (24.2-70)	-	7.3 (1.9-35)	Prospective	0-1 safety	Interview	-	Median:160 d
	RARP, 200	Tewari et al[34], 2003		59.9 (40-72)	27.7 (19-38)	58.8 (18-140)		6.4 (0.6-41)		pad			Median:44 d^a
3/2/2(H)	RRP, 105	Ficarra et al[35], 2008	Italy	65 (61-69)	26 (24-28)	40 (30-47)	-	6 (5-10)	Prospective	0 pad	ICIQ-UI	N	-	88.0 (92/105)
	RARP, 103	Ficarra et al[35], 2008		61 (57-67)	26 (24-28)	37.5 (30-48)		6.4 (4.6-9)						97.0^a (100/103)
3/2/3(H)	RRP, 110	Ham et al[36], 2008	South Korea	66.9 ± 6.0	23.6 ± 1.8	-	-	55.2 ± 23.7	Prospective	0 pad	Validated	N	75.5 (83/110)	81.8 (90/110)
	RARP, 188	Ham et al[36], 2008		67.3 ± 6.2	23.6 ± 2.3			22.3 ± 34.3			questionnaire		87.2 (164/188)	92.0^a (173/188)
3/1/2(M)	RRP, 75	Di Pierro et al[37], 2010	Switzerland	64.3 (59.1-68.0)	-	-	-	7.57 (5.1-10.4)	Prospective	0 pad	Institutional	Y, > 20%	83.0 (62/75)	80.0 (60/75)
	RARP, 75	Di Pierro et al[37], 2010		62.8 (58.4-67.0)				7.72 (5.6-12.1)			questionnaire		95.0^a (71/75)	89^a (40/45)
1/1/1(L)	RRP, 235	Kim et al[10], 2011	South Korea	66.5 ± 5.7	-	18.2 ± 23.4	-	14.6 ± 22.1	Prospective	0 pad	Validated	-	Median: 4.3 mo
	RARP, 528	Kim et al[10], 2011		64.2 ± 7.3		15.2 ± 20.2		10.4 ± 16.0			questionnaire		Median: 3.7 mo
4/2/3(H)	RRP, 109	Geraerts et al[38], 2013	Belgium	62.22 ± 6.12	-	-	-	-	Prospective	24h pad	Validated	N	94.0 (102/109)	96.0 (105/109)
	RARP, 61	Geraerts et al[38], 2013		61.48 ± 6.08						test	questionnaire		95.0 (58/61)	97.0 (59/61)
2/1/2(M)	RRP, 62	Caballero et al[39], 2008	Spain	66.5 (62-69)	-	41 (30.15-52)	-	9.66 (7-16.6)	Retrospective	0 pad	Unspecified	Y, < 20%	45.9 (28/61)	-
	RARP, 60	Caballero et al[39], 2008		56 (56-65.25)		29.5 (23-40)		7 (5.7-10)					60.0 (30/50)^a
2/0/1(L)	RRP, 588	Krambeck et al[11], 2008	United States	61.0 (41.0-77.0)	-	-	-	5.0 (0.6-39.7)	Retrospective	0 pad	Institutional	Y, < 20%		93.7 (446/476)
	RARP, 294	Krambeck et al[11], 2008		61.0 (38.0-76.0)				4.9 (0.5-33.5)			questionnaire			91.8 (224/244)
3/1/2(M)	RRP, 240	Rocco et al[40], 2009	Italy	63 (46-77)	-	-	6 (4-10)	6.7 (0.7-22.0)	Retrospective	0-1 safety	Interview	Y, > 20%	83.0 (189/229)	88.0 (191/217)
	RARP, 120	Rocco et al[40], 2009		63 (47-76)			6 (4-9)	6.9 (0.4-23.0)		pad			93.0^a (102/110)	97.0^a (77/79)
3/1/3(H)	RRP, 30	Ou et al[41], 2009	United States	70.03 ± 6.10	24.09 ± 3.28	15.89 ± 14.15	6.22 ± 1.62	-	Retrospective	0-1 safety	Unspecified	N	83.3 (25/30)	96.6 (29/30)
	RARP, 30	Ou et al[41], 2009		67.27 ± 6.21	24.22 ± 3.16	16.45 ± 18.80	6.13 ± 0.9			pad			96.7 (29/30)	100.0 (30/30)
3/2/3(H)	RRP, 176	Choo et al[42], 2013	South Korea	67 ± 6.25	24 ± 2.73	42 ± 18.82	-	7.6 ± 19.33	Retrospective	0-1 safety	Validated	N	92.0 (162/176)	96.0 (169/176)
	RARP, 77	Choo et al[42], 2013		66 ± 7.75	24 ± 2.55	41 ± 15.77		7.2 ± 13.19		pad	questionnaire		84.0 (65/77)	94.0 (72/77)
3/1/3(H)	RRP, 112	Son et al[43], 2013	South Korea	65.0 ± 6.1	24.3 ± 2.4	41.3 ± 30.0	-	-	Retrospective	0 pad	Validated	Y, < 20%	51.7 (49/94)	70.7 (66/94)
	RARP, 146	Son et al[43], 2013		65.5 ± 6.7	24.5 ± 2.5	45.9 ± 16.3					questionnaire		87.5^a (107/122)	94.5^a (115/122)

^aP < 0.05. RRP: Retropubic radical prostatectomy; RARP: Robot-assisted radical prostatectomy; ICIQ-UI: International consultation of incontinence questionnaire-urinary incontinence.

Table 3 Comparative studies evaluating urinary continence recovery after laparoscopic radical prostatectomy or robot-assisted radical prostatectomy

Quality	Case, n	Author, yr	Country	Age (yr)	BMI(kg/m²)	Prostate vol-ume (mL,g)	Gleason sco-re (biopsy)	PSA (ng/mL)	Studydesign	Continence definition	Data collection	Loss of follow-up (N/Y, %)	Urinary continence recovery, %(n)
Quality	Case, n	Author, yr	Country	Age (yr)	BMI(kg/m²)	Prostate vol-ume (mL,g)	Gleason sco-re (biopsy)	PSA (ng/mL)	Studydesign	Continence definition	Data collection	Loss of follow-up (N/Y, %)	6 mo	12 mo
High	LRP, 60	Asimakopoulos et al[44], 2011	Italy	61.1 ± 5.1	26.3 ± 2.2	-	-	7.37 (1.5-9.15)	RCT	0 pad	ICS-MSF	N	75.0 (45/60)	83.0 (50/60)
	RARP, 52	Asimakopoulos et al[44], 2011		59.6 ± 5.4	25.8 ± 2.6			8.9 (5.8-9.2)					88.0 (46/52)	94.0 (49/52)
High	LRP, 60	Porpiglia et al[45], 2012	Italy	64.7 ± 5.9	26.8 ± 2.9	37.7 ± 14.1	-	8.3 ± 6.5	RCT	0-1 pad	EPIC	N	73.3 (44/60)	83.3 (50/60)
	RARP, 60	Porpiglia et al[45], 2012		63.9 ± 6.7	26.2 ± 2.5	36.2 ± 12.6		6.9 ± 4.2					88.3a (53/60)	95.0^a (57/60)
3/1/3(H)	LRP, 1377	Ploussard et al[46], 2012	France	62.7	26.6	-	-	9.8	Prospective	0 pad	Validated	N	58.9 (811/1377)	68.5 (943/1377)
	RARP, 1009	Ploussard et al[46], 2012		62.7	26.5			9.2			questionnaire		72.0^a (726/1009)	75.4 (761/1009)
2/1/2(M)	LRP, 50	Joseph et al[47], 2005	United Kingdom	61.8 ± 1.6	-	-	6 ± 0.14	6.0 ± 0.83	Retrospective	0 pad	Interview	N	92.0 (46/50)	-
	RARP, 50	Joseph et al[47], 2005	United Kingdom	59.6 ± 1.6			6 ± 0.15	7.3 ± 1.2					90.0 (45/50)
2/1/2(M)	LRP, 70	Caballero et al[39], 2008	Spain	66.5 (62-69)	-	41 (30.15-52)	-	9.66 (7-16.6)	Retrospective	0 pad	Unspecified	Y, < 20%	36.4 (24/66)	-
	RARP, 60	Caballero et al[39], 2008		56 (56-65.25)		29.5 (23-40)		7 (5.7-10)					60.0 (30/50)
3/1/3(H)	LRP, 31	Lee et al[48], 2009	South Korea	63.0 ± 8.52	25.2 ± 2.59	37.4 ± 13.05	6.5 ± 1.23	11.7 ± 13.72	Retrospective	0-1 safety	Institutional	N	80.6 (25/31)	-
	RARP, 21	Lee et al[48], 2009		64.6 ± 6.79	25.5 ± 2.64	39.9 ± 15.54	6.6 ± 0.97	8.1 ± 7.01		pad	questionnaire		81.0 (17/21)
3/1/2(M)	LRP, 60	Cho et al[49], 2009	South Korea	66.5 (57-75)	23.65 (18.1-28.4)	39.7 (19-72)	6.81 (5-9)	11.04 (2.72-36.6)	Retrospective	0-1 safety	Interview	N	71.7 (43/60)	100.0 (60/60)
	RARP, 60	Cho et al[49], 2009		66.3 (50-77)	24.61 (19.9-26.3)	36.6 (22-92.8)	6.83 (5-8)	9.98 (2.91-26.3)		pad			93.3 (56/60)	100.0 (60/60)
4/2/3(H)	LRP, 75	Hakimi et al[50], 2009	United States	59.6 (43-72)	-	-	-	7.5	Retrospective	0 pad	IPSS	N	65.3 (49/75)	89.3 (67/75)
	RARP, 75	Hakimi et al[50], 2009		59.8 (42-71)				8.4					74.7 (56/75)	93.3 (70/75)
4/2/2(H)	LRP, 45	Trabulsi et al[51], 2010	United States	58.1 (43-74)	-	-	-	6.2	Retrospective	0-1 safety	Validated	N	71.0 (32/45)	82.0 (37/45)
	RARP, 205	Trabulsi et al[51], 2010		59.9 (42-76)				6.4		pad	questionnaire		91.0^a (187/205)	94.0^a (193/205)
3/2/2(H)	LRP, 161	Willis et al[52], 2011	United States	58.0 ± 6.7	27.0 ± 3.4	35.2 ± 10.1	-	5.7 ± 2.9	Retrospective	0 pad	Validated	Y, > 20%	55.0 (64/117)	72.0 (84/116)
	RARP, 121	Willis et al[52], 2011		58.1 ± 6.3	26.7 ± 3.3	41.5 ± 15.2		5.0 ± 2.2			questionnaire		66.0 (50/76)	75.0 (33/44)
3/1/2(M)	LRP, 62	Park et al[53], 2011	South Korea	65.7 (38-77)	24.6 (19.4-31.4)	30.1 (12.0-56.0)	-	9.14 (2.65-30.77)	Retrospective	0-1 safety	Interview	N	76.3 (47/62)	95.0 (59/62)
	RARP, 44	Park et al[53], 2011		62.7 (46-71)	26.0 (19.7-39.4)	32.9 (15.5-66.8)		6.32 (1.86-29.5)		pad			93.5 (41/44)	94.4 (42/44)
3/2/3(H)	LRP, 144	Park et al[54], 2013	South Korea	67 (38-77)	24.2 (17.2-31.4)	28.8 (12.0-74.0)	-	5.84 (0.08-41.26)	Retrospective	0 pad	Interview	N	65.5 (94/144)	78.1 (112/144)
	RARP, 183	Park et al[54], 2013		63 (44-75)	24.7 (16.4-39.4)	30.3 (15.5-82.8)		4.98 (0.05-51.46)					83.5^a (153/183)	87.4 (160/183)

^aP < 0.05. LRP: Laparoscopic radical prostatectomy; RARP: Robot-assisted radical prostatectomy; RCT: Randomized controlled trial; IPSS: International prostate symptom score; EPIC: Expanded prostate cancer index composite; ICS-MSF: International continence society-male short form questionnaire.

Table 4 Comparative studies evaluating potency recovery after retropubic radical prostatectomy or laparoscopic radical prostatectomy

Quality	Case, n	Author, yr	Country	Age (yr)	BMI (kg/m²)	Prostate vol-ume (mL, g)	Gleason sc-ore (biopsy)	PSA (ng/mL)	Study design	Potency definition	Data collection	Loss of follow-up (N/Y, %)	Potency recovery(UNS/BNS),%(n)		Potency recovery(unclear NS), %(n)
Quality	Case, n	Author, yr	Country	Age (yr)	BMI (kg/m²)	Prostate vol-ume (mL, g)	Gleason sc-ore (biopsy)	PSA (ng/mL)	Study design	Potency definition	Data collection	Loss of follow-up (N/Y, %)	6 mo	12 mo	6 mo	12 mo
3/2/2(H)	RRP, 70	Anastasiadis et al[20], 2003	France	64.8 ± 6.4	-	-	6.1 ± 1.1	11.2 ± 9.7	Prospective	ESI	Nonvalidated	Y, > 20%	-	71.0 (23/33)	-	30.0 (10/33)
	LRP, 230	Anastasiadis et al[20], 2003	France	64.1 ± 6.4			5.8 ± 1.2	10.7 ± 8.8			questionnaire			98.0 (104/106)		41.0 (43/106)
2/2/3(H)	RRP, 33	Roumeguere et al[21], 2003	Belgium	63.9 ± 5.5	-	42.0 ± 20.4	5.4 ± 1.5	10.5 ± 11.5	Prospective	ESI	IIEF-5	N	33.3 (11/33)	54.5 (18/33)	-	-
	LRP, 26	Roumeguere et al[21], 2003	Belgium	62.5 ± 6.0		37.3 ± 15.6	5.4 ± 1.5	8.6 ± 5.2					34.6 (9/26)	65.3 (17/26)
3/2/3(H)	RRP, 25	Wagner et al[23], 2007	United States	59 ± 6.9	29 ± 4.5	-	-	8.1 ± 6.27	Prospective	ESI	EPIC	N	-	44.0 (11/25)	-	-
	LRP, 37	Wagner et al[23], 2007	United States	58 ± 6.9	27 ± 3.0			6.2 ± 4.22						41.0 (15/37)
3/2/2(H)	RRP, 164	Touijer et al[24], 2008	United States	59 (54, 64)	-	-	-	5.3 (4.1, 7.3)	Prospective	ESI	Institutional	N	-	-	-	58.5 (96/164)
	LRP, 132	Touijer et al[24], 2008	United States	60 (55, 65)				5.3 (4.0, 7.5)			questionnaire					56.2 (73/130)
3/2/3(H)	RRP, 150	Greco et al[25], 2009	Italy	61.5 (49-74)	29 (25-33)	-	5 (3-7)	6.95 (3.4-10)	Prospective	ESI	IIEF-5	N	-	51.0 (77/150)	-
	LRP, 150	Greco et al[25], 2009	Italy	60.5 (45-76)	32 (26-38)		5 (3-7)	6.3 (2.4-10)						66.0^a (99/150)
3/2/2(H)	RRP, 102	Dahl et al[26], 2009	United States	59.9	-	-	-	-	Prospective	ESI	Validated	Y, > 20%	-	-	23.0 (18/77)	32.0 (23/73)
	LRP, 104	Dahl et al[26], 2009	United States	59.5							questionnaire				37.0 (28/75)	43.0 (33/77)
3/1/2(M)	RRP, 50	Artibani et al[28], 2003	Italy	64.28 ± 6.6	-	-	5.7 ± 1.2	11 ± 9	Retrospective	ESI	Nonvalidated	Y, < 20%	-	-	10.0 (4/40)	-
	LRP, 71	Artibani et al[28], 2003	Italy	63.14 ± 5.8			5.8 ± 1.3	15.7 ± 17			questionnaire				8.8 (5/57)
4/2/2(H)	RRP, 42	Ghavamian et al[29], 2006	United States	57.8 ± 7.3	28.1	53.2 (19-135)	6.7 ± 1.3	9.9 ± 7.1	Retrospective	ESI	IIEF-5	N	38.1 (16/42)	52.5 (21/40)	-	-
	LRP, 50	Ghavamian et al[29], 2006	United States	60.8 ± 6.1	27.5	40.8 (20-114)	6.4 ± 0.8	7.6 ± 8.0					48.0 (24/50)	64.0 (32/50)
2/1/1(M)	RRP, 128	Springer et al[32], 2013	Germany	57.2 ± 7.4	28.3 ± 2.6	-	-	3.1 ± 1.7	Retrospective	IIEF-5 > 22	IIEF-5	N	-	53.1 (68/128)	-	-
	LRP, 125	Springer et al[32], 2013	Germany	56.8 ± 6.7	27.7 ± 3.8			3.2 ± 1.4						74.4^a (93/125)
3/2/2(H)	RRP, 143	Magheli et al[33], 2014	Germany	62.6 ± 5.4	-	58 ± 22	-	10.1 ± 11.9	Retrospective	IIEF-5 > 17	Validated	Y, > 20%	-	29.0 (18/62)	-	-
	LRP, 79	Magheli et al[33], 2014	Germany	62.3 ± 5.7		53 ± 20		9.2 ± 6.9			questionnaire			28.0 (7/25)

^aP < 0.05. RRP: Retropubic radical prostatectomy; LRP: Laparoscopic radical prostatectomy; ESI: Erection sufficient for intercourse; IIEF: International index of erectile function; EPIC: Expanded prostate cancer index composite; UNS: Unilateral nerve sparing; PSA: Prostate-specific antigen; BNS: Bilateral nerve sparing.

Table 5 Comparative studies evaluating potency recovery after retropubic radical prostatectomy or robot-assisted radical prostatectomy

Quality	Case, n	Author, yr	Country	Age (y)	BMI (kg/m²)	Prostate vol-ume (mL, g)	Gleason sc-ore (biopsy)	PSA (ng/mL)	Study design	Potency definition	Data collection	Loss of follow-up (N/Y,%)	Potency recovery(UNS/BNS), %(n)		Potency recovery (unclear NS), %(n)
Quality	Case, n	Author, yr	Country	Age (y)	BMI (kg/m²)	Prostate vol-ume (mL, g)	Gleason sc-ore (biopsy)	PSA (ng/mL)	Study design	Potency definition	Data collection	Loss of follow-up (N/Y,%)	6 mo	12 mo	6 mo	12 mo
3/2/3(H)	RRP, 100	Tewari et al[34], 2003	United States	63.1 (42.8-72)	27.6 (17-41)	48.4 (24.2-70)	-	7.3 (1.9-35)	Prospective	Presence of	Interview	-	Median: 440 d		Median:440 d
	RARP, 200	Tewari et al[34], 2003	United States	59.9 (40-72)	27.7 (19-38)	58.8 (18-140)		6.4 (0.6-41)		erection			Median: 180 d^a		Median:180 d^a
3/2/2(H)	RRP, 41	Ficarra et al[35], 2008	Italy	65 (61-69)	26 (24-28)	40 (30-47)	-	6 (5-10)	Prospective	IIEF-5 > 17	IIEF-5	N	-	49.0 (20/41)	-	-
	RARP, 64	Ficarra et al[35], 2008	Italy	61 (57-67)	26 (24-28)	37.5 (30-48)		6.4 (4.6-9)						81.0^a (52/64)
3/2/3(H)	RRP, 81	Ham et al[36], 2008	South Korea	66.9 ± 6.0	23.6 ± 1.8	-	-	55.2 ± 23.7	Prospective	ESI	IIEF-5	N	-	40.7 (33/81)	-	-
	RARP, 164	Ham et al[36], 2008	South Korea	67.3 ± 6.2	23.6 ± 2.3			22.3 ± 34.3						66.5 (109/164)
3/1/2(M)	RRP, 49	Di Pierro et al[37], 2010	Switzer- land	64.3 (59.1-68.0)	-	-	-	7.57 (5.1-10.4)	Prospective	ESI	Institutional	Y, > 20%	-	-	25.0 (12/49)	26.0 (12/47)
	RARP, 37	Di Pierro et al[37], 2010	Switzer- land	62.8 (58.4-67.0)				7.72 (5.6-12.1)			questionnaire				68.0 (25/37)	55.0 (12/22)
1/1/1(L)	RRP, 122	Kim et al[10], 2011	South Korea	66.5 ± 5.7	-	18.2 ± 23.4	-	14.6 ± 22.1	Prospective	ESI	Validated	N	-	-	6.7 (8/122)	28.1 (34/122)
	RARP, 373	Kim et al[10], 2011	South Korea	64.2 ± 7.3		15.2 ± 20.2		10.4 ± 16.0			questionnaire				33.0 (123/373)	57.1 (213/373)
2/0/1(L)	RRP, 588	Krambeck et al[11], 2008	United States	61.0 (41.0-77.0)	-	-	-	5.0 (0.6-39.7)	Retrospective	ESI	Institutional	Y, > 20%	-	-	-	62.8 (262/417)
	RARP, 294	Krambeck et al[11], 2008	United States	61.0 (38.0-76.0)				4.9 (0.5-33.5)			questionnaire					70.0 (142/203)
3/1/2(M)	RRP, 240	Rocco et al[40], 2009	Italy	63 (46-77)	-	-	6 (4-10)	6.7 (0.7-22.0)	Retrospective	ESI	Interview	Y, > 20%	-	-	31.0 (71/229)	41.0 (88/215)
	RARP, 120	Rocco et al[40], 2009	Italy	63 (47-76)			6 (4-9)	6.9 (0.4-23.0)							43.0 (46/107)	61.0 (48/79)
3/1/3(H)	RRP, 2	Ou et al[41], 2009	United States	70.03 ± 6.10	24.09 ± 3.28	15.89 ± 14.15	6.22 ± 1.62		Retrospective	Presence of	Unspecified	N	-	50.0 (1/2)	-	-
	RARP, 16	Ou et al[41], 2009	United States	67.27 ± 6.21	24.22 ± 3.16	16.45 ± 18.80	6.13 ± 0.9			erection				87.5.0 (14/16)
3/2/3(H)	RRP, 55	Choo et al[42], 2013	South Korea	67 ± 6.25	24 ± 2.73	42 ± 18.82		7.6 ± 19.33	Retrospective	ESI	IIEF-5	N	15.0 (8/55)	40.0 (22/55)	-	-
	RARP, 41	Choo et al[42], 2013	South Korea	66 ± 7.75	24 ± 2.55	41 ± 15.77		7.2 ± 13.19					29.0 (12/41)	54.0 (22/41)

^aP < 0.05. RRP: Retropubic radical prostatectomy; RARP: Robot-assisted radical prostatectomy; ESI: Erection sufficient for intercourse; PSA: Prostate-specific antigen; IIEF-5: International index of erectile function; UNS: Unilateral nerve sparing; BNS: Bilateral nerve sparing.

Table 6 Comparative studies evaluating potency recovery after laparoscopic radical prostatectomy or robot-assisted radical prostatectomy

Quality	Case, n	Author, yr	Country	Age (yr)	BMI (kg/m²)	Prostate Volume (mL,g)	Gleason score (biopsy)	PSA (ng/mL)	Study design	Potency definition	Data collection	Loss of follow-up (N/Y, %)	Potency recovery (UNS/BNS), %(n)		Potency recovery (unclear NS), %(n)
Quality	Case, n	Author, yr	Country	Age (yr)	BMI (kg/m²)	Prostate Volume (mL,g)	Gleason score (biopsy)	PSA (ng/mL)	Study design	Potency definition	Data collection	Loss of follow-up (N/Y, %)	6 mo	12 mo	6 mo	12 mo
High	LRP, 60	Asimakopoulos et al[44], 2011	Italy	61.1 ± 5.1	26.3 ± 2.2	-	-	7.37 (1.5-9.15)	RCT	ESI	IIEF-6	N	-	-	22.0 (13/60)	32.0 (19/60)
	RARP, 52	Asimakopoulos et al[44], 2011	Italy	59.6 ± 5.4	25.8 ± 2.6			8.9 (5.8-9.2)							75.0^a (39/52)	77.0^a (40/52)
High	LRP, 35	Porpiglia et al[45], 2012	Italy	64.7 ± 5.9	26.8 ± 2.9	37.7 ± 14.1	-	8.3 ± 6.5	RCT	IIEF-5 > 17	IIEF-5	N	48.5 (17/35)	54.2 (19/35)	-	-
	RARP, 35	Porpiglia et al[45], 2012	Italy	63.9 ± 6.7	26.2 ± 2.5	36.2 ± 12.6		6.9 ± 4.2					65.7 (23/35)	80.0^a (28/35)
3/1/3(H)	LRP, 866	Ploussard et al[46], 2012	France	62.7	26.6	-	-	9.8	Prospective	ESI	IIEF-5	N	20.4 (177/866)	31.6 (274/866)	-	-
	RARP, 711	Ploussard et al[46], 2012	France	62.7	26.5			9.2					42.1 (299/711)	57.7 (410/711)
3/1/2(M)	LRP, 41	Cho et al[49],	South Korea	66.5 (57-75)	23.65 (18.1-28.4)	39.7 (19-72)	6.81 (5-9)	11.04 (2.72-36.6)	Retrospective	ESI	Interview	N	46.3 (19/41)	68.3 (28/41)	-	-
	RARP, 53	Cho et al[49],	South Korea	66.3 (50-77)	24.61 (19.9-26.3)	36.6 (22-92.8)	6.83 (5-8)	9.98 (2.91-26.3)					56.6 (30/53)	69.8 (37/53)
4/2/3(H)	LRP, 55	Hakimi et al[50], 2009	United States	59.6 (43-72)	-	-	-	7.5	Retrospective	Presence of	IIEF-5	N	47.3 (26/55)	65.5 (36/55)	-	-
	RARP, 58	Hakimi et al[50], 2009	United States	59.8 (42-71)				8.4		Erection			63.8 (37/58)	74.1 (43/58)
3/2/2(H)	LRP, 86	Willis et al[52], 2011	United States	58.0 ± 6.7	27.0 ± 3.4	35.2 ± 10.1	-	5.7 ± 2.9	Retrospective	ESI	Validated	Y, > 20%	57.0 (34/60)	67.0 (38/57)	-	-
	RARP, 74	Willis et al[52], 2011	United States	58.1 ± 6.3	26.7 ± 3.3	41.5 ± 15.2		5.0 ± 2.2			questionnaire		73.0 (29/40)	88.0 (21/24)
3/1/2(M)	LRP, 35	Park et al[53], 2011	South Korea	65.7 (38-77)	24.6 (19.4-31.4)	30.1 (12.0-56.0)	-	9.14 (2.65-30.77)	Retrospective	ESI	Interview	Y, > 20%	-	47.6 (10/21)	-	-
	RARP, 37	Park et al[53], 2011	South Korea	62.7 (46-71)	26.0 (19.7-39.4)	32.9 (15.5-66.8)		6.32 (1.86-29.5)						54.5 (12/22)
3/2/3(H)	LRP, 144	Park et al[54], 2013	South Korea	67 (38-77)	24.2 (17.2-31.4)	28.8 (12.0-74.0)	-	5.84 (0.08-41.26)	Retrospective	ESI	Interview	N	30.8 (26/83)	32.7 (27/83)	10.2 (15/144)	22.9 (33/144)
	RARP, 183	Park et al[54], 2013	South Korea	63 (44-75)	24.7 (16.4-39.4)	30.3 (15.5-82.8)		4.98 (0.05-51.46)					31.1 (49/156)	36.5 (57/156)	20.1 (37/183)	35.0 (64/183)

^aP < 0.05. LRP: Laparoscopic radical prostatectomy; RARP: Robot-assisted radical prostatectomy; RCT: Randomized controlled trial; ESI: Erection sufficient for intercourse; IIEF: International index of erectile function. EPIC: Expanded prostate cancer index composite; SHIM: Sexual health inventory for men; UNS: Unilateral nerve sparing; PSA: Prostate-specific antigen; BNS: Bilateral nerve sparing.

Table 7 Subgroup analyses of 6-mo urinary continence recovery after laparoscopic radical prostatectomy or retropubic radical prostatectomy

Subgroup	Study	Sample size	Heterogeneity I²(%)	P-value	Meta-analysis
					OR	95%CI
Country	Asia	553	63	0.06	0.45	0.20-1.04
	America	346	0	0.45	0.83	0.51-1.34
	Europe	763	80	0.40	1.46	0.60-3.55
Continence definition	0 pad	1662	74	0.52	0.84	0.50-1.41
	0-1 pad	0	-	-	-	-
Study design	prospective	968	77	0.55	1.24	0.61-2.50
Study design	retrospective	694	59	0.08	0.56	0.29-1.07
Loss of follow-up	≤ 20%	911	71	0.87	1.06	0.53-2.09
	> 20%	751	78	0.32	0.66	0.29-1.51

OR: Odds ratio; CI: Confidence

Table 8 Subgroup analyses of 12-mo urinary continence recovery after laparoscopic radical prostatectomy or retropubic radical prostatectomy

Subgroup	Study	Sample size	Heterogeneity I² (%)	P-value	Meta-analysis
					OR	95%CI
Country	Asia	553	72	0.18	0.38	0.09-1.54
	America	911	89	0.91	0.95	0.35-2.55
	Europe	1343	29	0.33	1.26	0.79-2.02
Continence	0 pad	908	55	0.75	1.08	0.68-1.69
definition	0-1 pad	754	88	0.27	0.53	0.17-1.63
Study design	prospective	509	83	0.51	1.26	0.63-2.53
Study design	retrospective	1153	57	0.15	0.60	0.30-1.20
Loss of follow-up	≤ 20%	451	82	0.82	1.09	0.51-2.33
	> 20%	1211	59	0.45	0.79	0.43-1.46

OR: Odds ratio; CI: Confidence interval.

Table 9 Subgroup analyses of 6-mo urinary continence recovery after robot-assisted radical prostatectomy or retropubic radical prostatectomy

Subgroup	Study	Sample size	Heterogeneity I² (%)	P-value	Meta-analysis
					OR	95%CI
Country	Asia	809	92	0.35	1.93	0.48-7.70
Country	Europe/America	862	0	< 0.01	2.32	1.47-3.67
Continence	0 pad	828	63	< 0.01	3.09	1.65-5.80
definition	0-1 pad	673	82	0.52	1.62	0.37-7.06
Study design	prospective	448	0	< 0.01	2.48	1.44-4.26
Study design	retrospective	1223	80	0.1	2.07	0.87-4.95
Loss of follow-up	≤ 20%	1161	80	0.1	2.00	0.88-4.53
	> 20%	510	0	< 0.01	2.99	1.55-5.77

OR: Odds ratio; CI: Confidence interval.

Table 10 Subgroup analyses of 12-mo potency recovery after nerve sparing procedures

Techniques	Subgroup	Sample size	Heterogeneity I² (%)	P-value	Meta-analysis
Techniques	Subgroup	Sample size	Heterogeneity I² (%)	P-value	OR	95%CI
LRP vs RRP	uni/bilateral NS	735	0	< 0.05	1.52	1.09-2.13
LRP vs RRP	unclear NS	802	22	0.37	1.17	0.83-1.65
RARP vs RRP	uni/bilateral NS	464	0	< 0.01	2.83	1.90-4.22
RARP vs RRP	unclear NS	446	0	< 0.01	2.43	1.52-3.90

RRP: Retropubic radical prostatectomy; LRP: Laparoscopic radical prostatectomy; RARP: Robot-assisted radical prostatectomy; OR: Odds ratio; CI: Confidence interval; NS: Nerve sparing.

Table 11 Meta-regression of 12-mo continence recovery

Techniques	Factors	Sample, n	Coefficient	P value	95%CI
					Lower CI	Upper CI
LRP vs RRP	Age	14	-0.0422414	0.480	-0.1685084	0.0840256
	Prostate Volume	7	0.0004602	0.976	-0.0367033	0.0376237
	Gleason Score	10	-0.0002758	0.998	-0.2325786	0.2320269
	PSA	11	0.0381884	0.508	-0.0871645	0.1635414
RARP vs RRP	Age	8	-0.0347693	0.763	-0.3038441	0.2343054
	BMI	5	0.178217	0.604	-0.8030416	1.159476
	Prostate Volume	4	0.0076432	0.912	-0.2556839	0.2709703
	PSA	5	0.0028508	0.882	-0.053367	0.0590685
RARP vs LRP	Age	6	-0.0026949	0.968	-0.1735327	0.1789224
	BMI	4	0.0709043	0.680	-0.7088789	0.5670703
	PSA	6	0.0275948	0.661	-0.1898594	0.1346698

RRP: Retropubic radical prostatectomy; LRP: Laparoscopic radical prostatectomy; RARP: Robot-assisted radical prostatectomy; CI: Confidence interval; PSA: Prostate-specific antigen; BMI: Body mass index.

Table 12 Meta-regression of 12-mo potency recovery

Techniques	Factors	Sample, n	Coefficient	P value	95%CI
					Lower CI	Upper CI
LRP vs RRP	Age	8	-0.0334222	0.682	-0.156947	0.2237914
	Gleason Score	5	-0.0059256	0.732	-0.5614423	0.4429304
	PSA	5	0.0509797	0.558	-0.1961242	0.2980837
RARP vs RRP	Age	6	-0.006352	0.939	-0.2221039	0.2093999
RARP vs RRP	PSA	5	0.0018209	0.892	-0.0373331	0.0409749
RARP vs LRP	Age	6	-0.0437647	0.535	-0.2229024	0.1353731
	BMI	5	0.1340739	0.315	-0.220684	0.4888318
	Prostate Volume	4	-0.0080152	0.894	-0.2365214	0.2204911
	PSA	6	0.0350044	0.588	-0.1301063	0.2001150

Citation: Shi MJ, Yang J, Meng XY, Li S, Liu T, Fang ZH, Cao R, Wang XH. Comparison of functional outcomes after retropubic, laparoscopic and robot-assisted radical prostatectomy: A meta-analysis. World J Meta-Anal 2014; 2(3): 107-126
URL: https://www.wjgnet.com/2308-3840/full/v2/i3/107.htm
DOI: https://dx.doi.org/10.13105/wjma.v2.i3.107